download standard form 5510 instructions

Application Status - Self Service Kiosk to view the status of an application submitted within the last 90 days. Find information about Medicare, how to apply, report fraud and complaints. In some states, plans may be available to persons under age 65 who are eligible for Medicare by reason of disability or End-Stage Renal Disease.

If you aren't enrolled in Medicare, complete an enrolment application form and submit the form at a Medicare service centre. ** DSS Field Offices and our staffed telephone Benefits Center (1-855-6-CONNECT or 1-85) are closed on Wednesdays to allow our staff time to process applications, renewals and related work. ** DSS Field Offices are now open Monday, Tuesday, Thursday and Friday, from 8 a.m. APPLICATION FOR MEDICARE SAVINGS PROGRAMS This is an application only for the following types of medical coverage: Qualified Medicare Beneficiary (QMB) Questions? Applying over the phone: call Social Security. New Medicare Card Application Form in PDF. Complete this form if you are an existing Medicare provider applying for a Medicare provider number for a new location, to re-open a closed location or to close an existing provider number.

Assistance with Medicare Costs Medicare Savings (also known as Buy-In)Programs Please note that this application is for Medicare Savings (Buy-In) Programs only and will not be used to determine eligibility for other MassHealth programs.

Download standard form 5510 instructions